EP0404427A1 - APNEA Preventive stimulating device - Google Patents

APNEA Preventive stimulating device Download PDF

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Publication number
EP0404427A1
EP0404427A1 EP90306452A EP90306452A EP0404427A1 EP 0404427 A1 EP0404427 A1 EP 0404427A1 EP 90306452 A EP90306452 A EP 90306452A EP 90306452 A EP90306452 A EP 90306452A EP 0404427 A1 EP0404427 A1 EP 0404427A1
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EP
European Patent Office
Prior art keywords
apnea
stimulating
respiration
upper airway
circuit
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Granted
Application number
EP90306452A
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German (de)
French (fr)
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EP0404427B1 (en
Inventor
Tamotsu Takishima
Wataru Hida
Hiroshi Miki
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Chest Corp
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Chest Corp
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Publication of EP0404427A1 publication Critical patent/EP0404427A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/3601—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of respiratory organs

Definitions

  • the present invention relates to an apnea preventive stimulating device for preventing the occurrence of trouble which results from abnormality in the respiratory function in one's sleep.
  • apnea which is accompanied by the sus­pension of breathing, for example, for 10 seconds or more in one's sleep at night.
  • apnea in one's sleep decreases the alveolar ventilation volume and the partial pressure of arterial oxygen difference (PaO2) and increases the partial pressure of arterial carbon dioxide (PaCO2), and further, it lowers the chemoreceptor sensitivity and raises the upper airway resistance, thus constituting a causative factor in aggravation of the arterial blood gas.
  • PaO2 partial pressure of arterial oxygen difference
  • PaCO2 partial pressure of arterial carbon dioxide
  • the breathing abnormality in one's sleep is a clinically important subject, and it is necessary to take measures for preventing the occurrence of the above-mentioned sleep-apnea.
  • An object of the present invention is to provide a device effective for preventing the above-said sleep-apnea.
  • an apnea preventive stimulating device characterized by the provision of: a respiration sensing circuit; a detection signal generator for detecting a respi­ration detection signal from the output of said respiration sensing circuit; an electric stimulating wave generating circuit which, when apnea has continued for 5 to 10 seconds after its detection by said detection signal generator, starts to operate and generates electric stimulating waves having a frequency of 40 to 100 Hz and a pulse peak value of 1 to 50 V; and a stimulating circuit composed of genioglossus stimulators which are supplied with the output of the said electric stimulating wave generating circuit.
  • the respiration sensing circuit is formed by a parallel circuit of sensors for sensing respiration through both nostrils and a sensor for sensing respiration through a mouth, or a microphone sensor to detect the breath tones.
  • the intensity of the electric stimulating waves can be ampli­fied at a predetermined time from a patient's bedtime, so that the lowering of stimulation on a patient by the electric stimulating wave during the patient's deep sleep is compen­sated for to wake up the patient.
  • the sleep-apnea syndrome is classified into a so-called central type caused by an abnormality in the respiratory center, an obstructive type by an upper airway obstruction, and a mixed type by a combination thereof.
  • the obstructive type is often observed clinically and is considered to be caused by a morphological abnormality in the upper airway tract, such as tonsillar hypertrophy or micrognathia, or by a tonus of the upper airway muscle for boradening the airway.
  • the inventors of this application have clarified by experiments that the upper airway can be recovered from obstruction which causes apnea stimulating the genioglossus, which is one of the dilator muscles of the upper airway, with pulses of a frequency of 40 to 150 Hz, a peak value of 1 to 50 volts and rise-up time constant of 0.2 seconds or more, and that control of the start and stop of the electric stimulation with apnea detection signals would make it possible to auto­matically take measures to deal with apnea even at night when it is particularly difficult to find a fit of apnea.
  • reference character A indicates a respiration sensing circuit, which includes the following elements.
  • Reference numerals 1 a , 1 b and 1 c designate thermistors.
  • the thermistors 1 a and 1 b are provided in anticipation of stuffing up of one of a patient's nostrils, for detecting one's respiration airflow through the both nostrils, and the thermistor 1 c is provided in anticipation of stuffing up of both nostrils, for observing respiration through the mouth.
  • These thermistors detect temperature variations caused by warm and cold air currents resulting from expiration and inspiration which are alternately repeated.
  • the thermistors are fixed as by a tape on the skin at the nostrils and on the mouth.
  • the out-­puts of the thermistors 1 a , 1 b and 1 c are connected in paral­lel to ensure checking whether the patient is breathing or not, even if two of the thermistors 1 a , 1 b and 1 c cannot detect the respiration because of their dislocation or patient's nosal congestion.
  • the respiration sensing circuit A formed by the thermistors yields such a substantially sinusoidally varying output signal as shown in Fig. 3(a) which goes positive and negative in response to the warm and cold air currents when the patient expires and inspires, respectively.
  • Reference numeral 2 identifies a sensor ampli­fier. By adjusting its amplification factor the detection sensitivity can freely be set so that a detection signal of a sufficiently high level can be obtained although the amount of respiration differs with individual patients.
  • Reference character B denotes a respiration detection signal generator, which includes the following elements.
  • Reference numeral 3 indicates a low-pass filter, which filters out noise signals from the low-frequency respiration detection signal available from the respiration sensing circuit A as shown in Fig. 3(b).
  • Reference numeral 4 denotes a zero crossing comparator, which provides a train of pulses which rise and fall at the zero points when the output waveform of Fig. 3(b) rises and falls, respectively, as shown in Fig. 3(c). The pulses are level shifted as depicted in Fig. 3(d), thus producing a respiration identification signal which is not delivered during the patient's non-­breathing state II .
  • Reference character C indicates an electric stimulating wave generating circuit, which includes the following elements.
  • Reference numeral 5 denotes a respiration identi­fying detector, which is formed by a retriggerable one-shot multivibrator circuit, for example, and its operation time constant is set to a value of 5 to 10 seconds which does not introduce the possibility of trouble being caused by apnea.
  • This circuit operates in such a manner that its output is held high-level as shown in Fig. 3(e) by the successive application thereto of the pulses of Fig.
  • Reference numeral 5 a denotes a start switch for test use.
  • Reference numeral 6 indicates an electric stimulating wave generator, which is provided with a switch 6 a for manually starting its operation so that electric stimulating waves can be generated at any time for checking out the oscillation of the stimulating wave generator.
  • a frequency setting knob 6 b is provided so that the repetition frequency of stimulation suitable to each patient can be adjusted in the range of between 40 and 150 Hz.
  • a time length setting circuit 6 c is provided, by which the generation of stimulating waves is automatically stopped when the state of apnea continues over a certain period of time and recovery from apnea can no longer be expected.
  • the electric stimulating wave generator starts to operate as shown in Fig. 3(f) and delivers electric stimulating waves as shown in Fig. 3(g).
  • the electric stimulating wave generator stops its operation and hence stops the generation of the electric simulating waves as shown in Fig. 3(g).
  • Reference numeral 7 indicates a stimulating wave amplifier and 7 a denotes a stimulation sensitivity adjuster, by which the amplification factor of the amplifier can be adjusted for setting its output voltage level within the range of 1 to 50 volts as desired.
  • Reference character D identifies a stimulating circuit composed of two conductive stimulating elements 8 and 9, which are fixed as by tape to the skin surface at the lower jaw at both sides of the Adam's apple as shown in Fig. 3.
  • the electric stimulating waves are applied to the genioglussus by the output of the electric stimulative wave generator 6 which is supplied to the stimulators 8 and 9.
  • the thermister sensor for detecting the air flows from the mouth and the nose is subjected to set the sensor and any necessary cord on the persons's face. This disturb a person in his or her sleep, or the cord may be disconnected at an accident.
  • the senor 10 comprises a microphone 10 a , a case 10 b , a cord 10 c and a sensing hole 10 d as shown in Figs. 6A and 6B.
  • the microphone sensor 10 is set on the neck of a patient as shown in Fig. 5 to detect the breath tones.
  • a modified sensor 11 having the microphone 10 a comprises further a stimulator 11 a on the surface, as shown in Fig. 7, and can be used as shown in Fig. 8 in addition to the sensor 10 at the neck.
  • the timer 7 b is attached to the sensitivity adjuster 7 a to amplify the intensity of the electric stimulating wave at a predetermined time (e.g. half an hour or one hour) from patient's bedtime, so that the lowering of stimulation on a patient by the electric stimulating wave during the patient's deep sleep is compensated for to wake up the patient.
  • a predetermined time e.g. half an hour or one hour
  • the amplification factor is 1.5 or 2 by way of example.
  • the present invention Since the present invention has such a construction as discribed above, a patient needs only to fix the sensors 1 a , 1 b and 1 c and the stimulators 8 and 9 at predetermined positions before going to bed, in which case if a patient has a fit of apnea in patient's sleep, the electric stimulative wave generator 6 provides automatically stimulus to the genioglossus, which causes decreasing the obstruction of the upper airway and recovering the breathing.
  • the present invention ensures the prevention of various diseases which are caused by the fit of apnea, and the invention achieved good results in clinical testing on patients.

Abstract

The sleep-apnea syndrome is classified into a so-called central type caused by an abnormality in the respiratory center, an obstructive type by an upper airway obstruction, and a mixed type by a combination thereof. Among the rest, the obstructive type is often observed clinically and is considered to be caused by a morphological abnormality in the upper airway tract, such as tonsillar hypertrophy or micrognathia, or by a tonus of the upper airway muscle for broadening the airway. The inventors of this application have clarified by experiments that the upper airway can be recovered from obstruction which causes apnea stimulating the genioglossus, which is one of the dilator muscles of the upper airway, with pulses of a frequency of 40 to 150 Hz, a peak value of 1 to 50 volts and a rise-up time constant of 0.2 seconds or more, and that control of the start and stop of the electric stimulation with apnea detection signals would make it possible to automatically take measures to deal with apnea even at night when it is particularly difficult to find a fit of apnea.

Description

  • The present invention relates to an apnea preventive stimulating device for preventing the occurrence of trouble which results from abnormality in the respiratory function in one's sleep.
  • Many studies have been reported on a so-called sleep-­apnea syndrome, i.e. apnea which is accompanied by the sus­pension of breathing, for example, for 10 seconds or more in one's sleep at night. Such apnea in one's sleep decreases the alveolar ventilation volume and the partial pressure of arterial oxygen difference (PaO₂) and increases the partial pressure of arterial carbon dioxide (PaCO₂), and further, it lowers the chemoreceptor sensitivity and raises the upper airway resistance, thus constituting a causative factor in aggravation of the arterial blood gas. This causes pulmonary hypertension, right-sided heart failure, arrhythmia, or brain brouble, which may sometimes result in a sudden death if worst comes to worst. Thus, the breathing abnormality in one's sleep is a clinically important subject, and it is necessary to take measures for preventing the occurrence of the above-mentioned sleep-apnea.
  • An object of the present invention is to provide a device effective for preventing the above-said sleep-apnea.
  • To attain the above object of the present invention, there is provided an apnea preventive stimulating device characterized by the provision of: a respiration sensing circuit; a detection signal generator for detecting a respi­ration detection signal from the output of said respiration sensing circuit; an electric stimulating wave generating circuit which, when apnea has continued for 5 to 10 seconds after its detection by said detection signal generator, starts to operate and generates electric stimulating waves having a frequency of 40 to 100 Hz and a pulse peak value of 1 to 50 V; and a stimulating circuit composed of genioglossus stimulators which are supplied with the output of the said electric stimulating wave generating circuit.
  • The respiration sensing circuit is formed by a parallel circuit of sensors for sensing respiration through both nostrils and a sensor for sensing respiration through a mouth, or a microphone sensor to detect the breath tones. The intensity of the electric stimulating waves can be ampli­fied at a predetermined time from a patient's bedtime, so that the lowering of stimulation on a patient by the electric stimulating wave during the patient's deep sleep is compen­sated for to wake up the patient.
  • The sleep-apnea syndrome is classified into a so-called central type caused by an abnormality in the respiratory center, an obstructive type by an upper airway obstruction, and a mixed type by a combination thereof. Among the rest, the obstructive type is often observed clinically and is considered to be caused by a morphological abnormality in the upper airway tract, such as tonsillar hypertrophy or micrognathia, or by a tonus of the upper airway muscle for boradening the airway.
  • The inventors of this application have clarified by experiments that the upper airway can be recovered from obstruction which causes apnea stimulating the genioglossus, which is one of the dilator muscles of the upper airway, with pulses of a frequency of 40 to 150 Hz, a peak value of 1 to 50 volts and rise-up time constant of 0.2 seconds or more, and that control of the start and stop of the electric stimulation with apnea detection signals would make it possible to auto­matically take measures to deal with apnea even at night when it is particularly difficult to find a fit of apnea.
  • The present invention will be described in detail below with reference to the accompanying drawings, in which:
    • Fig. 1 is a circuit diagram illustrating an embodiment of the present invention;
    • Figs. 2, 3 and 8 are schematic diagrams each showing the positions where to fix respiration detecting sensors and so on;
    • Fig. 3 shows waveform diagrams explanatory of the oper­ation of this invention device;
    • Fig. 4 is a circuit diagram illustrating another embodi­ment of the present invention; and
    • Fig. 6A, 6B and 7 are a perspective view and sections illustrating microphone sensors employed in the present invention. present invention.
  • With reference to Fig. 1 illustrating an embodiment of the present invention, reference character A indicates a respiration sensing circuit, which includes the following elements. Reference numerals 1a, 1b and 1c designate thermistors. The thermistors 1a and 1b are provided in anticipation of stuffing up of one of a patient's nostrils, for detecting one's respiration airflow through the both nostrils, and the thermistor 1c is provided in anticipation of stuffing up of both nostrils, for observing respiration through the mouth. These thermistors detect temperature variations caused by warm and cold air currents resulting from expiration and inspiration which are alternately repeated.
  • As shown in Fig. 2, the thermistors are fixed as by a tape on the skin at the nostrils and on the mouth. The out-­puts of the thermistors 1a, 1b and 1c are connected in paral­lel to ensure checking whether the patient is breathing or not, even if two of the thermistors 1a, 1b and 1c cannot detect the respiration because of their dislocation or patient's nosal congestion. The respiration sensing circuit A formed by the thermistors yields such a substantially sinusoidally varying output signal as shown in Fig. 3(a) which goes positive and negative in response to the warm and cold air currents when the patient expires and inspires, respectively. Reference numeral 2 identifies a sensor ampli­fier. By adjusting its amplification factor the detection sensitivity can freely be set so that a detection signal of a sufficiently high level can be obtained although the amount of respiration differs with individual patients.
  • Reference character B denotes a respiration detection signal generator, which includes the following elements. Reference numeral 3 indicates a low-pass filter, which filters out noise signals from the low-frequency respiration detection signal available from the respiration sensing circuit A as shown in Fig. 3(b). Reference numeral 4 denotes a zero crossing comparator, which provides a train of pulses which rise and fall at the zero points when the output waveform of Fig. 3(b) rises and falls, respectively, as shown in Fig. 3(c). The pulses are level shifted as depicted in Fig. 3(d), thus producing a respiration identification signal which is not delivered during the patient's non-­breathing state II .
  • Reference character C indicates an electric stimulating wave generating circuit, which includes the following elements. Reference numeral 5 denotes a respiration identi­fying detector, which is formed by a retriggerable one-shot multivibrator circuit, for example, and its operation time constant is set to a value of 5 to 10 seconds which does not introduce the possibility of trouble being caused by apnea. This circuit operates in such a manner that its output is held high-level as shown in Fig. 3(e) by the successive application thereto of the pulses of Fig. 3(d) during the patient's breathing state I and and when the breathing state is altered to the non-breathing state II at a time t₁ and the respiration identification signal is no longer applied, the output still remains high until a time t₂ after a certain elapsed time, for example, 5 seconds, thereafter going low. Reference numeral 5a denotes a start switch for test use.
  • Reference numeral 6 indicates an electric stimulating wave generator, which is provided with a switch 6a for manually starting its operation so that electric stimulating waves can be generated at any time for checking out the oscillation of the stimulating wave generator. A frequency setting knob 6b is provided so that the repetition frequency of stimulation suitable to each patient can be adjusted in the range of between 40 and 150 Hz. Further, a time length setting circuit 6c is provided, by which the generation of stimulating waves is automatically stopped when the state of apnea continues over a certain period of time and recovery from apnea can no longer be expected.
  • In a case where the patient lapses into the non-breath­ing state II at the time t₁ as shown in Fig. 3(d) and the output of the one-shot multivibrator circuit 5 goes low at the time t₂ five seconds thereafter as depicted in Fig. 3(e), the electric stimulating wave generator starts to operate as shown in Fig. 3(f) and delivers electric stimulating waves as shown in Fig. 3(g). When the respiration is recovered by the stimulation at a time t₃ and the output of the one-shot multivibrator circuit 5 goes high again as depicted in Fig. 3(f), the electric stimulating wave generator stops its operation and hence stops the generation of the electric simulating waves as shown in Fig. 3(g). Reference numeral 7 indicates a stimulating wave amplifier and 7a denotes a stimulation sensitivity adjuster, by which the amplification factor of the amplifier can be adjusted for setting its output voltage level within the range of 1 to 50 volts as desired.
  • Reference character D identifies a stimulating circuit composed of two conductive stimulating elements 8 and 9, which are fixed as by tape to the skin surface at the lower jaw at both sides of the Adam's apple as shown in Fig. 3. The electric stimulating waves are applied to the genioglussus by the output of the electric stimulative wave generator 6 which is supplied to the stimulators 8 and 9.
  • The thermister sensor for detecting the air flows from the mouth and the nose is subjected to set the sensor and any necessary cord on the persons's face. This disturb a person in his or her sleep, or the cord may be disconnected at an accident.
  • To overcome the above defect, another ambodiment of the present invention is shown in Fig. 4, in which a microphone can be employed as the sensor to detect breath tones. In this case, the sensor 10 comprises a microphone 10a, a case 10b, a cord 10c and a sensing hole 10d as shown in Figs. 6A and 6B. The microphone sensor 10 is set on the neck of a patient as shown in Fig. 5 to detect the breath tones.
  • A modified sensor 11 having the microphone 10a comprises further a stimulator 11a on the surface, as shown in Fig. 7, and can be used as shown in Fig. 8 in addition to the sensor 10 at the neck.
  • In the embodiment shown in Fig. 4, the timer 7b is attached to the sensitivity adjuster 7a to amplify the intensity of the electric stimulating wave at a predetermined time (e.g. half an hour or one hour) from patient's bedtime, so that the lowering of stimulation on a patient by the electric stimulating wave during the patient's deep sleep is compensated for to wake up the patient. In this case, the amplification factor is 1.5 or 2 by way of example.
  • Since the present invention has such a construction as discribed above, a patient needs only to fix the sensors 1a, 1b and 1c and the stimulators 8 and 9 at predetermined positions before going to bed, in which case if a patient has a fit of apnea in patient's sleep, the electric stimulative wave generator 6 provides automatically stimulus to the genioglossus, which causes decreasing the obstruction of the upper airway and recovering the breathing. Thus, the present invention ensures the prevention of various diseases which are caused by the fit of apnea, and the invention achieved good results in clinical testing on patients.

Claims (4)

1. An apnea preventive stimulating device comprising:
a respiration sensing circuit;
a detection signal generator for detecting a respiration detection signal from the output of said respiration sensing circuit;
an electric stimulating wave generating circuit which, when apnea has continued for 5 to 10 seconds after its detection by said detection signal generator, starts to operate and generates electric stimulating waves having a frequency of 40 to 100 Hz and a pulse peak value of 1 to 50 V; and
a stimulating circuit composed of genioglossus stimula­tors which are supplied with the output of the said electric stimulating wave generating circuit.
2. An apnea preventive stimulating device according to claim 1, characterized in that said respiration sensing circuit is formed by a parallel circuit of sensors for sensing respiration through both nostrils and a sensor sensing respiration through a mouth.
3. An apnea preventive stimulating device according to claim 1, characterized in that said respiration sensing circuit comprises a microphone sensor for setting on the neck of a patient to detect the breath tones.
4. An apnea preventive stimulating device according to claim 1, characterized in that said electric stimulating wave generating circuit comprises timer means for amplify the intensity of the electric stimulating wave at a prede­termined time from a patient's bedtime.
EP90306452A 1989-06-20 1990-06-13 APNEA Preventive stimulating device Expired - Lifetime EP0404427B1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP157218/89 1989-06-20
JP1157218A JP2794196B2 (en) 1989-06-20 1989-06-20 Apnea prevention stimulator

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EP0404427A1 true EP0404427A1 (en) 1990-12-27
EP0404427B1 EP0404427B1 (en) 1995-05-24

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EP (1) EP0404427B1 (en)
JP (1) JP2794196B2 (en)
DE (1) DE69019602T2 (en)

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US5178156A (en) 1993-01-12
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JPH0323870A (en) 1991-01-31
US5277193A (en) 1994-01-11
DE69019602T2 (en) 1996-02-01

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